Suppression of SIRT1 in Diabetic Conditions Induces Osteogenic Differentiation of Human Vascular Smooth Muscle Cells via RUNX2 Signalling

Vascular calcification is associated with significant morbidity and mortality within diabetes, involving activation of osteogenic regulators and transcription factors. Recent evidence demonstrates the beneficial role of Sirtuin 1 (SIRT1), an NAD⁺ dependant deacetylase, in improved insulin sensitivity and glucose homeostasis, linking hyperglycaemia and SIRT1 downregulation. This study aimed to determine the role of SIRT1 in vascular smooth muscle cell (vSMC) calcification within the diabetic environment. An 80% reduction in SIRT1 levels was observed in patients with diabetes, both in serum and the arterial smooth muscle layer, whilst both RUNX2 and Osteocalcin levels were elevated. Human vSMCs exposed to hyperglycaemic conditions in vitro demonstrated enhanced calcification, which was positively associated with the induction of cellular senescence, verified by senescence-associated β-galactosidase activity and cell cycle markers p16 and p21. Activation of SIRT1 by SRT1720 reduced Alizarin red staining by a third, via inhibition of the RUNX2 pathway and prevention of senescence. Conversely, inhibition of SIRT1 via Sirtinol and siRNA increased RUNX2 by over 50%. These findings demonstrate the key role that SIRT1 plays in preventing calcification in a diabetic environment, through the inhibition of RUNX2 and senescence pathways, suggesting a downregulation of SIRT1 may be responsible for perpetuating vascular calcification in diabetes.

Clinical management and research priorities for high-risk prostate cancer in the UK: Meeting report of a multidisciplinary panel in conjunction with the NCRI Prostate Cancer Clinical Studies Localised Subgroup

The management of high-risk prostate cancer has become increasingly sophisticated, with refinements in radical therapy and the inclusion of adjuvant local and systemic therapies. Despite this, high-risk prostate cancer continues to have significant treatment failure rates, with progression to metastasis, castrate resistance and ultimately disease-specific death. In an effort to discuss the challenges in this field, the UK National Clinical Research Institute’s Prostate Cancer Clinical Studies localised subgroup convened a multidisciplinary national meeting in the autumn of 2014. The remit of the meeting was to debate and reach a consensus on the key clinical and research challenges in high-risk prostate cancer and to identify themes that the UK would be best placed to pursue to help improve outcomes. This report presents the outcome of those discussions and the key recommendations for future research in this highly heterogeneous disease entity.

Monomeric C-reactive protein--a key molecule driving development of Alzheimer's disease associated with brain ischaemia?

Alzheimer’s disease (AD) increases dramatically in patients with ischaemic stroke. Monomeric C-reactive protein (mCRP) appears in the ECM of ischaemic tissue after stroke, associating with microvasculature, neurons and AD-plaques, Aβ, also, being able to dissociate native-CRP into inflammatory, mCRP in vivo. Here, mCRP injected into the hippocampal region of mice was retained within the retrosplenial tract of the dorsal 3rd ventrical and surrounding major vessels. Mice developed behavioural/cognitive deficits within 1 month, concomitant with mCRP staining within abnormal looking neurons expressing p-tau and in beta-amyloid 1-42-plaque positive regions. mCRP co-localised with CD105 in microvessels suggesting angiogenesis. Phospho-arrays/Western blotting identified signalling activation in endothelial cells and neurons through p-IRS-1, p-Tau and p-ERK1/2-which was blocked following pre-incubation with mCRP-antibody. mCRP increased vascular monolayer permeability and gap junctions, increased NCAM expression and produced haemorrhagic angiogenesis in mouse matrigel implants. mCRP induced tau244–372 aggregation and assembly in vitro. IHC study of human AD/stroke patients revealed co-localization of mCRP with Aβ plaques, tau-like fibrils and IRS-1/P-Tau positive neurons and high mCRP-levels spreading from infarcted core regions matched reduced expression of Aβ/Tau. mCRP may be responsible for promoting dementia after ischaemia and mCRP clearance could inform therapeutic avenues to reduce the risk of future dementia.

Endothelial microparticles as conveyors of information in atherosclerotic disease

Endothelial microparticles (EMPs) are complex submicron membrane-shed vesicles released into the circulation following endothelium cell activation or apoptosis. They are classified as either physiological or pathological, with anticoagulant or pro-inflammatory effects respectively. Endothelial dysfunction caused by inflammation is a key initiating event in atherosclerotic plaque formation. Athero-emboli, resulting from ruptured carotid plaques are a major cause of stroke. Current clinical techniques for arterial assessment, angiography and carotid ultrasound, give accurate information about stenosis but limited evidence on plaque composition, inflammation or vulnerability; as a result, patients with asymptomatic, or fragile carotid lesions, may not be identified and treated effectively. There is a need to discover novel biomarkers and develop more efficient diagnostic approaches in order to stratify patients at most risk of stroke, who would benefit from interventional surgery. Increasing evidence suggests that EMPs play an important role in the pathogenesis of cardiovascular disease, acting as a marker of damage, either exacerbating disease progression or triggering a repair response. In this regard, it has been suggested that EMPs have the potential to act as biomarkers of disease status. In this review, we will present the evidence to support this hypothesis and propose a novel concept for the development of a diagnostic device that could be implemented in the clinic.

Testicular microlithiasis: is it significant?

Previously considered to be a benign finding on scrotal ultrasonography, testicular microlithiasis (TM) is now recognized as a condition associated with the development of testicular neoplasia. Despite this the management of TM remains unclear. We review the evidence for this association and suggested management strategies.

Pharmacokinetic and safety profile of raltegravir and ribavirin, when dosed separately and together, in healthy volunteers

BACKGROUND

Treatment of chronic hepatitis C virus (HCV) infection in HIV-1-co-infected individuals remains challenging due to numerous factors, including drug-drug interactions. The aim of this study was to assess the safety and pharmacokinetic (PK) profile of raltegravir and ribavirin when dosed separately and together.

METHODS

Fourteen healthy volunteers [mean (standard deviation) age 35 (10) years, 71% male] entered this phase 1 PK study and received single-dose ribavirin (800 mg) on day 1 (phase 1). Following a washout period, subjects received raltegravir (400 mg twice daily) on days 15-19 (phase 2) and single-dose ribavirin (800 mg) with raltegravir (400 mg) on day 20 (phase 3). Intensive PK sampling was undertaken on days 1, 19 and 20 and differences in geometric mean ratios (GMRs) for PK parameters between study periods were assessed.

RESULTS

No statistically significant differences in PK parameters were observed for raltegravir between phases 2 and 3. A statistically significant decrease in maximum plasma concentration (C(max)) and an increase in time to maximum plasma concentration (T(max)) were observed for ribavirin in phase 3 compared with phase 1 [GMR (95% confidence interval) 0.79 (0.62-1.00) and 1.39 (1.08-1.78), respectively], whereas no significant differences in other ribavirin PK parameters were observed between study phases. No clinically significant safety concerns were reported.

CONCLUSIONS

The PK profile of ribavirin is altered when administered with raltegravir (reduced C(max) and increased T(max)), with no safety concerns identified. This is unlikely to be of clinical significance or have an impact on the antiviral effects of ribavirin in HIV-1- and HCV-co-infected subjects.

Measuring patient satisfaction in sexually transmitted infection clinics: a systematic review

OBJECTIVES

Measuring patient satisfaction is an important aspect of making services attractive to patients and improving service delivery, and outpatient-based clinics are increasingly assessing service quality using patient-based outcome measures. No systematic review of patient satisfaction in sexually transmitted infection clinics has previously been performed. The objectives of the review were: (1) to establish how patient satisfaction with sexual health services has been defined and measured; (2) to identify whether a "gold standard" method exists; and (3) to identify the themes regarded by patients as priorities for delivering a quality service within a sexually transmitted infection clinic setting.

METHODS

A search of eight electronic journal databases and unpublished data sources was used to identify studies measuring patient satisfaction in a sexually transmitted infection clinic setting. Following initial review of each abstract, data from eligible studies were extracted by two independent reviewers and content analysis used to identify common themes.

RESULTS

Eighteen questionnaire-based studies, nine semistructured interviews and four other studies, including three focus groups, fulfilled the selection criteria for inclusion. Three studies incorporated more than one method of analysis. No common validated method of assessing patient satisfaction was identified. Themes reported to be of greatest importance were the convenience of clinic location, availability of appointments, staff attitude to patients, effective provision of information and maintenance of confidentiality.

CONCLUSIONS

This review has identified the need for a validated and standardised approach to assess patient satisfaction in sexually transmitted infection clinics. Comparing studies which have measured satisfaction, clear themes for the provision of a high quality service, from a patient perspective, have emerged. These themes should be incorporated into assessment tools, such as questionnaires, when reviewing service delivery.

Immediate dual energy X-ray absorptiometry reveals a high incidence of osteoporosis in patients with advanced prostate cancer before hormonal manipulation

OBJECTIVE

To examine the incidence of osteoporosis in patients with advanced prostate cancer (using forearm densitometry) before commencing androgen deprivation therapy (ADT), as osteoporotic fractures are more frequent in patients with prostate cancer who have undergone either medical or surgical castration, because of rapid loss of bone mass.

PATIENTS AND METHODS

In all, 174 patients (mean age 74.6 years, range 46-90) with advanced prostate cancer presented over 2 years. Their forearm bone densitometry values were compared with those from 106 age-matched controls (mean age 74.3 years, range 66-90).

RESULTS

Of the 174 patients, 73 (42%) were osteoporotic (t score <or=- 2.5) and 65 (37%) were osteopenic (t score - 1 to - 2.4). This compares with a 27% incidence of osteoporosis in the control group (P = 0.022). There were also no significant correlations between prostate specific antigen levels, Gleason score, tumour stage, biochemical markers and the presence or absence of osteoporosis risk factors.

CONCLUSION

Patients with advanced prostate cancer requiring ADT have a high incidence of osteoporosis before treatment. In addition, osteoporosis in these men cannot be predicted from clinical or biochemical values. Therefore, bone densitometry should be used in all patients with advanced cancer requiring ADT, as the results have implications for the choice of cancer therapy and the prophylaxis for osteoporosis.

A molecular phylogenetic analysis of reproductive trait evolution in the soft coral genus Alcyonium

The soft coral genus Alcyonium is among the most reproductively diverse invertebrate taxa known: The genus includes species that vary both in mode of reproduction (including broadcast spawners, internal brooders, and external brooders) and sexual expression (gonochores, hermaphrodites, and a unisexual parthenogen). Such diversity offers a unique opportunity to examine associations between reproductive and morphological traits in a phylogenetic context. We used an approximately 900-bp sequence of the nuclear ribosomal gene complex spanning the internal transcribed spacer (ITS) regions to construct a molecular phylogeny for 14 European and North American species of Alcyonium onto which we mapped the known distribution of reproductive and morphological traits. The phylogeny suggests that hermaphroditism or parthenogenesis has evolved independently at least twice in this genus, and always in internally brooding species. Broadcast spawning and external brooding only occur in species with large colony size, whereas all species with small colony size brood their larvae internally. Internal brooding and small size appear to be ancestral in this genus; if this is the case, an association between broadcast spawning and large colony size has evolved independently in at least two clades. This tendency of small adults to brood their larvae while large adults broadcast spawn them into the plankton has been observed in a variety of solitary invertebrate taxa, but to date has not been documented in any other colonial invertebrates. Moreoever, it has been suggested that organisms with a colonial growth form should not experience the allometric constraints on brood space that have been proposed to explain the association between adult size and mode of reproduction in solitary organisms. Unlike many other colonial groups, however, module (polyp) size is strongly correlated with colony size in Alcyonium, and constraints on brooding may be imposed by module, rather than colony, allometry. The very close genetic relationship (< 1% sequence divergence) and shared polymorphisms among A. digitatum (a large, gonochoric broadcast spawner), A. siderium, and A. sp. A (intermediate-sized and small hermaphroditic, internal brooders) suggest that evolutionary transitions between broadcast spawning and brooding and between gonochorism and hermaphroditism can occur easily and rapidly in this group.

Cervical cancer and sexual lifestyle: a systematic review of health education interventions targeted at women

A systematic review was conducted to determine the effectiveness of health education interventions to promote sexual risk reduction behaviours amongst women in order to reduce transmission of human papillomavirus (HPV), a leading agent in the development of cervical cancer. A comprehensive search was conducted to identify relevant studies. Studies were included in the review if they evaluated educational interventions targeting women only and measured the impact on either a behavioural outcome such as condom use for sexual intercourse, partner reduction or abstinence, or a clinical outcome such as incidence of a STD. Thirty studies met the inclusion criteria for the review; all had the primary aim of preventing HIV and other STDs rather than cervical cancer. Ten of the 30 studies were considered to provide the strongest evidence for a causal relationship between the intervention and the change in outcomes measured. Each of these 10 most rigorous studies showed a statistically significant positive effect on sexual risk reduction, typically with increased use of condoms for vaginal intercourse. This positive effect was generally sustained up to 3 months after intervention. It was concluded that educational interventions targeting socially and economically disadvantaged women in which information provision is complemented by sexual negotiation skill development can encourage at least short-term sexual risk reduction behaviour. This effect has the potential to reduce the transmission of HPV and thus possibly reduce the incidence of cervical carcinoma.

Interventions for encouraging sexual lifestyles and behaviours intended to prevent cervical cancer

BACKGROUND

Cervical cancer is one of the most common cancers affecting women world-wide. Prevention falls into two main categories - primary and secondary. Primary prevention is characterised by health promotion to promote lifestyles and behaviours minimising risk of cervical cancer. Interventions to promote the use of condoms for sexual intercourse (especially early intercourse amongst young women), sexual partner reduction, and negotiated safer sex strategies has been recommended as one approach to limit the spread of Human Papilloma Virus (HPV), one of the major risk factors for cervical cancer.

OBJECTIVES

To determine the effectiveness of health education interventions to promote sexual risk reduction behaviours amongst women in order to reduce transmission of HPV.

SEARCH STRATEGY

Electronic searching of EMBASE, ERIC, MEDLINE, PsycLIT, Social Science Citation Index and the CCTR were undertaken using a highly sensitive search strategy. Hand-searching took place of selected journals and reference lists.

SELECTION CRITERIA

Studies were included if they evaluated educational interventions targeting women only, and measured the impact on : either a behavioural outcome such as condom use for sexual intercourse, partner reduction, or abstinence; or a clinical outcome such as incidence of a sexually transmitted disease (STD).

DATA COLLECTION AND ANALYSIS

Data were extracted and methodological quality was assessed independently by two reviewers and any discrepancies were resolved between them. Ten per cent of the total number of studies were reviewed additionally by a third reviewer as a quality check and differences in judgement were resolved accordingly.

MAIN RESULTS

Thirty trials met the inclusion criteria for the review. All of them had the primary aim of preventing HIV and other STDs rather than cervical cancer. Four core methodological qualities were present in 10 of the 30 studies and constitute the subset from which potentially reliable conclusions may be drawn. Each of the 10 studies showed a statistically significant positive effect on sexual risk reduction, typically with increased use of condoms for vaginal intercourse. This positive effect was generally sustained up to three months after intervention.

REVIEWER'S CONCLUSIONS

Educational interventions targeting socially and economically disadvantaged women in which information provision is complemented by sexual negotiation skill development can encourage at least short-term sexual risk reduction behaviour. This has the potential to reduce the transmission of HPV, thus possibly reduce the incidence of cervical carcinoma.

Health economics. Perfect combination

The assumption by some HAs that a shift from mono to combination drug therapies for HIV results in a proportional increase in drug expenditure, regardless of health gains, is misguided. Methods of calculating anti-HIV drug expenditure have failed to keep up with changing treatment regimes. There is an urgent need to change the way data on antiretroviral use is collected and presented to establish the true cost-effectiveness of new drug regimes.

What is health promotion? How does it relate to the workplace? A background paper to support the Conference in Berlin on 29-30 September, 1994

Can workplaces be successful health promotion settings? Undoubtedly they can, in both direct and indirect ways. Directly, in being cost effective for companies, and indirectly, in improving the health and well being of all who work in a company. Under European directives the workplace has a responsibility to promote health promotion: this goes beyond health and safety, and protection of the workforce. Using WHO healthy policy principles, workplaces can be seen as a microcosm of society and therefore the principles of health promoting policies can be used to encourage healthy companies.

Cancer prevention in the UK

There has been concerted action in the UK to reduce mortality and morbidity from cancer, especially lung cancer. With the evolution and development of positive health promotion through life-style programmes, many aspects of the Europe Against Cancer programme's 10-point code for living are integrated into existing programmes. Whilst health promotion programmes in the UK have, for many years, concentrated on the promotion of positive health, the priority for action to reduce deaths from cancer has been focused on lung cancer. The UK government's report on the health of the nation has provided a further endorsement of education programmes aimed to reduce deaths from cancer.

Europe Against Cancer: Cancer Week UK

Since the beginning of the Europe Against Cancer (EAC) programme in 1989, much support and emphasis has been given to informing both health professionals and the public about cancer. This has come from the government and the many cancer-related charities and organizations. A week focused on cancer throughout the European Union (EU) has been encouraged each October. This paper describes the gradual development of these weeks to provide a more planned, co-ordinated and evaluated strategy. Collaboration with European partners is also addressed, emphasizing the positive benefits of such activities. Finally, the issue of monitoring and evaluation is addressed in some detail.

Cancer communication: the health promotion challenge

The way of communicating messages about cancer is the essence of this paper. There is a challenge to promote health, and demystify misconceptions about cancer and its treatment. But how do you reach those who seldom read or who are illiterate? How do you convince people that early presentation of symptoms that may be caused by cancer can positively influence outcome? How can you present a practical and realistic message about life-style factors and cancer? This paper explains initiatives in the UK to address some of these issues. The role of research and evaluation is important, but so are the ethical issues when you may be trying to persuade and convince the public of the benefits of life-style change. Finally, the issue of training of health professionals is addressed.

Cholesterol screening in a community health promotion program: epidemiologic results from a biracial population

The prevalence and interrelationship of high blood cholesterol levels with other cardiovascular disease risk factors were studied in a biracial suburb of New York City. Participants in community-based screenings to determine blood cholesterol levels have been predominantly white women in older age groups, highly educated and nonsmokers. To reach a more representative segment of a local population and promote healthy lifestyle behaviors, cholesterol screenings were conducted within an ongoing health promotion program in Mount Vernon, NY. Plasma cholesterol levels were determined for 5,011 participants, including 2,308 whites and 1,778 blacks. Of the men, 29 percent had high cholesterol levels; among women, it was 27 percent. Of the men with high levels, half had levels greater than 200 milligrams per deciliter, as did 55 percent of the women. After statistical adjustments were made for age and other risk factors for high blood cholesterol, mean cholesterol levels were higher for whites than blacks. The level for white men was 204 milligrams per deciliter; for women, 212. For black men, the level was 199 milligrams per deciliter; for women, 208, P < .10. Hispanic men had levels of 199, P < .10. The levels for Hispanic women (203 milligrams per deciliter) were significantly lower than that of white women. Among whites who smoked more than 1 pack of cigarettes per day, mean cholesterol levels were 11 milligrams per deciliter higher than for those who never smoked or were light smokers (0, 1-20 cigarettes per day, P < .10). There were too few who smoked more than 1 pack to test this association adequately among blacks. The mean cholesterol levels for hypertensive black men were 10 milligrams per deciliter greater than for black men with normal blood pressure (P<.10).

How sensitive are immunometric assays for thyrotropin?

The usual method for calculation of the "sensitivity" of thyrotropin immunometric assays is multireplicate analysis of the zero analyte standard. Although this is a statistically valid estimate of the scatter likely to be found in the response variable, it is unrelated to normal analytical practice (usually analysis in duplicate) and estimates intra-assay errors only. This study was designed to assess the analytical performance of 10 immunometric assays used routinely for measurement of thyrotropin in human serum. Response data from each assay were accumulated to provide (a) an estimate of "sensitivity" from multireplicate analysis and (b) an estimate of "minimum detection limit," relating directly to errors associated with routine performance and derived from a minimum of 500 duplicate analyses. We conclude that the "minimum detection limit" should be promoted as a more meaningful measure of assay performance at low analyte concentrations than the "sensitivity" derived from multireplicate analysis of the zero-analyte standard.

How sensitive are immunometric assays for thyrotropin?

The usual method for calculation of the "sensitivity" of thyrotropin immunometric assays is multireplicate analysis of the zero analyte standard. Although this is a statistically valid estimate of the scatter likely to be found in the response variable, it is unrelated to normal analytical practice (usually analysis in duplicate) and estimates intra-assay errors only. This study was designed to assess the analytical performance of 10 immunometric assays used routinely for measurement of thyrotropin in human serum. Response data from each assay were accumulated to provide (a) an estimate of "sensitivity" from multireplicate analysis and (b) an estimate of "minimum detection limit," relating directly to errors associated with routine performance and derived from a minimum of 500 duplicate analyses. We conclude that the "minimum detection limit" should be promoted as a more meaningful measure of assay performance at low analyte concentrations than the "sensitivity" derived from multireplicate analysis of the zero-analyte standard.

Video EEG telemetry using an ambulatory EEG cassette recorder

A system of video/EEG monitoring is described which is complementary to out-patient ambulatory EEG recording and prolonged hospital admission for intensive assessment. An ambulatory EEG cassette recorder is incorporated in the system which increases the usefulness of this equipment. In addition all the recorded EEG may be rapidly reviewed. This system has proved valuable in the management of selected patients seen in a special clinic for epilepsy.

Plasma alpha fetoprotein reference ranges in infancy: effect of prematurity

The dearth of plasma alpha fetoprotein reference ranges for preterm infants often impairs the clinical interpretation of plasma alpha fetoprotein data collected from ill babies. This study tested our hypothesis that meaningful plasma reference ranges could be established for preterm infants by a simple correction of patient age at sampling date for gestational age deficit at birth. Using a modified radioimmunoassay kit method, determinations of alpha fetoprotein were performed on capillary and venous blood samples collected from 56 babies aged from birth to 5 months with gestational ages ranging from 26 weeks to 43 weeks. Unmodified plasma alpha fetoprotein values were grouped according to patient age and examined statistically using established normal theory methods, but these yielded excessively wide reference intervals and non-Gaussian distribution parameters. Acceptable reference ranges were derived using logarithmic transformation of plasma alpha fetoprotein values and rearrangement against patient age corrected for gestational age deficit. These provisional reference ranges for plasma alpha fetoprotein in preterm (and term) infants are applied to groups of previously meaningless alpha fetoprotein results and used to test the potential usefulness of plasma alpha fetoprotein determination as a diagnostic marker in biliary atresia, hepatitis, and yolk sac derived tumours.

The community residential treatment service: developing a continuum of prosthetic environments for the chronically disabled

Among the many issues regarding the care of chronic mental patients, none is more pressing than the need for administrative and clinical models designed to organize and systematize the efforts of diverse community service providers. This paper describes the functioning of the Community Residential Treatment Service of the South Beach Psychiatric Center, a large-scale project of a state facility created to respond to this tissue. By blending sophisticated clinical and administrative technology, programs operated by the state, voluntary, and proprietary health care sectors have been integrated to form a balanced service delivery system. This system provides a broad continuum of inpatient and outpatient residential settings developed in accordance with social learning principles. The components of the system, with the Community Residential Treatment Service as the major integrative force, are linked together by detailed contracts as well as common behavioral clinical and behavioral administrative language. The treatment successes f this system have been significant enough to suggest that a positive synergistic effect is generated by this programming combination.